Korean Journal of Health Promotion

Cho, Kim, Kim, Jung, Yoon, Kim, and Bae: Association between Alcohol Drinking and the Ratio of Aspartate Aminotransferase to Alanine Aminotransferase in Korean Adult Male

Original Article: Published online: June 30, 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.2.64; Association between Alcohol Drinking and the Ratio of Aspartate Aminotransferase to Alanine Aminotransferase in Korean Adult Male; Young Hee Cho, Jong Sung Kim, Sung Soo Kim, Jin Kyu Jung, Seok Joon Yoon, Hyeun Young Kim, Yoon Kyung Bae; Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea.; Corresponding author: Jong Sung Kim, MD, PhD. Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea.
Tel: +82-42-280-8172, Fax: +82-42-280-7879, josephkim@cnu.ac.kr; Received March 06, 2017 Accepted June 05, 2017; Copyright © 2017 Korean Society for Health Promotion and Disease Prevention

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: The aspartate transaminase (AST)/alanine transferase (ALT) ratio increases with alcohol consumption. This study investigated AST/ALT ratio according to alcohol drinking and predictive power of AST/ALT ratio for heavy drinking in Korean men.

Methods: In 2015, 830 men with no history of disease or medication affecting liver function values were selected. Using 14 g of alcohol as the standard glass, odd ratios (ORs) of AST/ALT ratio over 1 among the drinking group were compared with the non-drinking group by multiple logistic analyses. Screening of heavy drinkers was conducted according to both NIAAA and Korean guidelines. Using AST/ALT ratio >1, sensitivity, specificity, positive predictive values, negative predictive values, positive likelihood ratios, negative likelihood ratios and odds ratios were investigated.

Results: After correcting for age, body mass index, exercising, and smoking history, ORs (95% confidence interval) of AST/ALT >1 were 1.607 (1.048-2.464) in <8 glasses group, 2.172 (1.160-4.065) in the 14 glasses group, and 3.670 (2.218-6.053) in the >14 glasses group. When AST/ALT >1 in the drinking group, sensitivity, specificity, positive predictive values, negative predictive values, likelihood ratios (LR)+, LR- and OR according to NIAAA guidelines, were 57.2%, 52.7%, 23.2%, 76.8%, 1.21 (1.04-1.41), 0.81 (0.67-0.98), and 1.49 (1.05-2.01), respectively. By Korean guidelines, these values were 55.2%, 55.3%, 33.7%, 66.3%, 1.24 (1.03-1.36), 0.84 (0.72-0.98), and 1.40 (1.04-1.89), respectively.

Conclusions: Healthy male adults showed a positive correlation between risk of AST/ALT >1 and drinking amount compared to the non-drinking group. Use of the AST/ALT >1 in combination with other blood markers to predict excessive drinking is advisable.

Key words: Alcohol drinking; Aspartate aminotransferase; Alanine transaminase; National Institute on Alcohol Abuse and Alcoholism (U.S.)

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Table 1

General characteristics of subjects

Abbreviations: AST, aspartate transaminase; ALT, alanine transferase.

Values are presented as mean±standard deviation or number (%).

P-value were calculated by Chi-square test for categorical variable or by ANOVA with scheffe post hoc for continuous variables.

^a1 standard drink: Ethanol 14 g.

Table 2

Odds ratio for AST/ALT >1 according to drinking amount

^aCalculated by Logistic regression with adjustment for age, body mass index, smoking and exercise.

Table 3

Distribution of subjects according to AST/ALT >1 and drinking

Abbreviations: AST, aspartate transaminase; ALT, alanine transferase; NIAAA, National Institute on Alcohol Abuse and Alcoholism.

Values are presented as number.

Table 4

Usefulness of AST/ALT >1 for screening of heavy drinking considering NIAAA guideline and Korean guideline

Abbreviations: AST, aspartate transaminase; ALT, alanine transferase; NIAAA, National Institute on Alcohol Abuse and Alcoholism; CI, confidence interval.

Values are presented as number (%), unless otherwise stated.

Calculated by Likelihood ratio test for LR(+/-) and logistic regression test for odds ratio (95% CI).

Table 5

Cut-off point of AST/ALT ratio for predicting heavy drinking according to NIAAA guideline and Korean guideline

Abbreviations: AST, aspartate transaminase; ALT, alanine transferase; NIAAA, National Institute on Alcohol Abuse and Alcoholism; AUROC, area under the receiver operating characteristic curve; CI, confidence interval.

Proper cut off value calculated by receiver operating characteristic (ROC) curves analysis.